隔药灸治疗脾胃气虚型糖尿病胃轻瘫的疗效观察
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摘要
目的观察隔药灸三门穴(梁门、关门、滑肉门)治疗脾胃气虚型糖尿病胃轻瘫的临床疗效。方法将126例脾胃气虚型糖尿病胃轻瘫患者随机分为治疗组、对照1组和对照2组,每组42例。治疗组给予隔药灸"三门穴"治疗,对照1组给予隔药灸常规腧穴(足三里、天枢、中脘)治疗,对照2组采用口服枸橼酸莫沙必利片治疗。治疗6周后观察各组胃轻瘫主要症状指数量表(GCSI)各项评分(早饱、胃胀、恶心呕吐、食欲不振)及各项中医症状(脘腹胀满、食欲不振、疲乏无力、恶心呕吐)评分的变化情况,并比较各组治疗前后4 h胃排空率及临床疗效。结果 3组治疗后GCSI各项评分、各项中医症状评分及治疗后4 h胃排空率与同组治疗前比较,差异均具有统计学意义(P<0.05)。治疗组治疗后GCSI各项评分、各项中医症状评分及治疗后4 h胃排空率与对照1组和对照2组比较,差异均具有统计学意义(P<0.05)。治疗组总有效率为92.9%,对照1组为81.0%,对照2组为66.7%,治疗组总有效率与对照1组和对照2组比较,差异具有统计学意义(均P<0.05)。结论隔药灸"三门穴"能明显改善脾胃气虚型糖尿病胃轻瘫患者的临床症状及胃排空率,临床疗效显著。
Objective To observe the clinical efficacy of herb-partitioned moxibustion at San Men acupoints[Liangmen(ST21), Guanmen(ST22), Huaroumen(ST24)] in treating diabetic gastroparesis due to spleen-stomach qi deficiency. Method A total of 126 patients with diabetic gastroparesis due to spleen-stomach qi deficiency were randomized into a treatment group, control group 1 and control group 2, with 42 cases in each group. The treatment group was given herb-partitioned moxibustion at San Men points; control group 1 was intervened by herb-partitioned moxibustion at ordinary acupoints [Zusanli(ST36), Tianshu(ST25), Zhongwan(CV12)]; control group 2 received oral administration of mosapride citrate tablets. Before and after 6-week treatment, the component scores of Gastroparesis Cardinal Symptom Index(GCSI)(early fullness, gastric bloating, nausea and vomiting, poor appetite) and the symptom scores of traditional Chinese medicine(abdominal bloating, poor appetite, fatigue, nausea and vomiting)were observed, and the gastric emptying rate 4 h before and after treatment and the clinical efficacies of the three groups were compared. Result After treatment, the GCSI component scores, symptom scores of traditional Chinese medicine and gastric emptying rate 4 h after treatment all changed significantly in the three groups(P<0.05).After treatment, the GCSI component scores, traditional Chinese medicine symptom scores and gastric emptying rate 4 h after treatment in the treatment group were significantly different from those in control group 1 and control group 2(P<0.05). The total effective rate was 92.0% in the treatment group, versus 81.0% in control group 1 and 66.7% in control group 2, and the rate in the treatment group was significantly different from that in control group 1 and control group 2(both P<0.05). Conclusion Herb-partitioned moxibustion at San Men points can markedly improve the clinical symptoms and gastric emptying rate in patients with diabetic gastroparesis due to spleen-stomach qi deficiency, and the clinical efficacy is significant.
Objective To observe the clinical efficacy of herb-partitioned moxibustion at San Men acupoints[Liangmen(ST21), Guanmen(ST22), Huaroumen(ST24)] in treating diabetic gastroparesis due to spleen-stomach qi deficiency. Method A total of 126 patients with diabetic gastroparesis due to spleen-stomach qi deficiency were randomized into a treatment group, control group 1 and control group 2, with 42 cases in each group. The treatment group was given herb-partitioned moxibustion at San Men points; control group 1 was intervened by herb-partitioned moxibustion at ordinary acupoints [Zusanli(ST36), Tianshu(ST25), Zhongwan(CV12)]; control group 2 received oral administration of mosapride citrate tablets. Before and after 6-week treatment, the component scores of Gastroparesis Cardinal Symptom Index(GCSI)(early fullness, gastric bloating, nausea and vomiting, poor appetite) and the symptom scores of traditional Chinese medicine(abdominal bloating, poor appetite, fatigue, nausea and vomiting)were observed, and the gastric emptying rate 4 h before and after treatment and the clinical efficacies of the three groups were compared. Result After treatment, the GCSI component scores, symptom scores of traditional Chinese medicine and gastric emptying rate 4 h after treatment all changed significantly in the three groups(P<0.05).After treatment, the GCSI component scores, traditional Chinese medicine symptom scores and gastric emptying rate 4 h after treatment in the treatment group were significantly different from those in control group 1 and control group 2(P<0.05). The total effective rate was 92.0% in the treatment group, versus 81.0% in control group 1 and 66.7% in control group 2, and the rate in the treatment group was significantly different from that in control group 1 and control group 2(both P<0.05). Conclusion Herb-partitioned moxibustion at San Men points can markedly improve the clinical symptoms and gastric emptying rate in patients with diabetic gastroparesis due to spleen-stomach qi deficiency, and the clinical efficacy is significant.
引文
[1]褚璐,王建军,邢晓燕.糖尿病胃轻瘫的早期诊断及发病机制探讨[J].世界中医药,2014,9(9):1181-1183.
[2]董江涛.三仁汤加减治疗湿热内蕴型功能性消化不良的疗效及其机理研究[J].云南中医中药杂志,2018,39(4):55-57.
[3]王诗才,施秀娟,邓钰杰,等.糖尿病胃轻瘫中医辨证分型文献再评价[J].中医临床研究,2015,7(20):42-44.
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[6]Camilleri M,Parkman HP,Shafi MA,et al.Clinical guideline:management of gastroparesis[J].Am JGastroenterol,2013,108(1):18-37.
[7]郑筱萸.中药新药临床研究指导原则[S].北京:中国医药科技出版社,2002:135-139.
[8]Zhang MH,Fang XS,Guo JY,et al.Effects of AMPK on Apoptosis and Energy Metabolism of Gastric Smooth Muscle Cells in Rats with Diabetic Gastroparesis[J].Cell Biochem Biophys,2019,77(2):165-177.
[9]Fehnel S,Fiedorek FT,Nelson L,et al.Development and psychometric evaluation of the Diabetic Gastroparesis Symptom Severity Diary[J].Clin Exp Gastroenterol,2019,12:93-103.
[10]Lin CL,Chen KC,Wu JM,et al.Gastric peroral endoscopic pyloromyotomy for refractory diabetic gastroparesis:First case report in Taiwan[J].Asian J Surg,2019,42(5):641-643.
[11]Revicki DA,Speck RM,Lavoie S,et al.The American neurogastroenterology and motility society gastroparesis cardinal symptom index-daily diary(ANMS GCSI-DD):Psychometric evaluation in patients with idiopathic or diabetic gastroparesis[J].Neurogastroenterol Motil,2019,31(4):e13553.
[12]Revicki DA,Lavoie S,Speck RM,et al.The content validity of the ANMS GCSI-DD in patients with idiopathic or diabetic gastroparesis[J].J Patient Rep Outcomes,2018,2(1):61.
[13]Majanovi?SK,Zeli?M,Belan?i?A,et al.Gastric Electrical Stimulation Improves Symptoms of Diabetic Gastroparesis in Patients on Peritoneal Dialysis-2 Case Reports[J].Perit Dial Int,2018,38(3):458-462.
[14]Mussa BM,Sood S,Verberne AJ.Implication of neurohormonal-coupled mechanisms of gastric emptying and pancreatic secretory function in diabetic gastroparesis[J].World J Gastroenterol,2018,24(34):3821-3833.
[15]雷辉.糖尿病胃轻瘫发病机制及治疗方法分析[J].中国医学创新,2014,11(1):152-154.
[16]吴会玲,娄侠,段立志,等.糖尿病胃轻瘫患者血胃泌素、胃动素水平的观察[J].临床荟萃,2014,29(7):800-801.
[17]Mahjoub F,Salari R,Yousefi M,et al.Effect of Pistacia atlantica kurdica gum on diabetic gastroparesis symptoms:a randomized,triple-blind placebo-controlled clinical trial[J].Electron Physician,2018,10(7):6997-7007.
[18]张子健,闫晨,张铭慧,等.莫沙必利治疗糖尿病性胃轻瘫的系统评价[J].中国医院用药评价与分析,2015,15(3):314-317.
[19]Liu L,Guo X,Wu XF,et al.Effect of acupuncture at points selected from different regions on SCF-kit signaling pathway in diabetic gastroparesis rats[J].JAcupunct Tuina Sci,2017,15(2):67-73.
[20]孙建华.针刺加闪罐治疗老年2型糖尿病胃轻瘫临床观察[J].上海针灸杂志,2018,37(10):1132-1135.
[21]姚金,唐雨兰.针刺治疗糖尿病胃轻瘫的临床随机对照研究[J].成都中医药大学学报,2018,41(1):75-78.
[22]冯庆春.中西医结合治疗糖尿病性胃轻瘫的诊治进展[J].实用糖尿病杂志,2018,14(2):70-71.
[23]陈永,乐毅敏,杨宗保,等.梁门穴的基础研究及临床运用[J].江西中医学院学报,2012,24(4):17-21.
[24]陈建华,孙祎.关门穴与治疗部位神经相关性解剖学研究[J].中国中医药现代远程教育,2015,13(5):67-68.
[25]赵志恒,付田昊,焦召华,等.“门”穴与脏腑经络的规律探析[J].四川中医,2015,33(7):15-17.
[2]董江涛.三仁汤加减治疗湿热内蕴型功能性消化不良的疗效及其机理研究[J].云南中医中药杂志,2018,39(4):55-57.
[3]王诗才,施秀娟,邓钰杰,等.糖尿病胃轻瘫中医辨证分型文献再评价[J].中医临床研究,2015,7(20):42-44.
[5]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)[J].中华糖尿病杂志,2014,6(7):447-498.
[6]Camilleri M,Parkman HP,Shafi MA,et al.Clinical guideline:management of gastroparesis[J].Am JGastroenterol,2013,108(1):18-37.
[7]郑筱萸.中药新药临床研究指导原则[S].北京:中国医药科技出版社,2002:135-139.
[8]Zhang MH,Fang XS,Guo JY,et al.Effects of AMPK on Apoptosis and Energy Metabolism of Gastric Smooth Muscle Cells in Rats with Diabetic Gastroparesis[J].Cell Biochem Biophys,2019,77(2):165-177.
[9]Fehnel S,Fiedorek FT,Nelson L,et al.Development and psychometric evaluation of the Diabetic Gastroparesis Symptom Severity Diary[J].Clin Exp Gastroenterol,2019,12:93-103.
[10]Lin CL,Chen KC,Wu JM,et al.Gastric peroral endoscopic pyloromyotomy for refractory diabetic gastroparesis:First case report in Taiwan[J].Asian J Surg,2019,42(5):641-643.
[11]Revicki DA,Speck RM,Lavoie S,et al.The American neurogastroenterology and motility society gastroparesis cardinal symptom index-daily diary(ANMS GCSI-DD):Psychometric evaluation in patients with idiopathic or diabetic gastroparesis[J].Neurogastroenterol Motil,2019,31(4):e13553.
[12]Revicki DA,Lavoie S,Speck RM,et al.The content validity of the ANMS GCSI-DD in patients with idiopathic or diabetic gastroparesis[J].J Patient Rep Outcomes,2018,2(1):61.
[13]Majanovi?SK,Zeli?M,Belan?i?A,et al.Gastric Electrical Stimulation Improves Symptoms of Diabetic Gastroparesis in Patients on Peritoneal Dialysis-2 Case Reports[J].Perit Dial Int,2018,38(3):458-462.
[14]Mussa BM,Sood S,Verberne AJ.Implication of neurohormonal-coupled mechanisms of gastric emptying and pancreatic secretory function in diabetic gastroparesis[J].World J Gastroenterol,2018,24(34):3821-3833.
[15]雷辉.糖尿病胃轻瘫发病机制及治疗方法分析[J].中国医学创新,2014,11(1):152-154.
[16]吴会玲,娄侠,段立志,等.糖尿病胃轻瘫患者血胃泌素、胃动素水平的观察[J].临床荟萃,2014,29(7):800-801.
[17]Mahjoub F,Salari R,Yousefi M,et al.Effect of Pistacia atlantica kurdica gum on diabetic gastroparesis symptoms:a randomized,triple-blind placebo-controlled clinical trial[J].Electron Physician,2018,10(7):6997-7007.
[18]张子健,闫晨,张铭慧,等.莫沙必利治疗糖尿病性胃轻瘫的系统评价[J].中国医院用药评价与分析,2015,15(3):314-317.
[19]Liu L,Guo X,Wu XF,et al.Effect of acupuncture at points selected from different regions on SCF-kit signaling pathway in diabetic gastroparesis rats[J].JAcupunct Tuina Sci,2017,15(2):67-73.
[20]孙建华.针刺加闪罐治疗老年2型糖尿病胃轻瘫临床观察[J].上海针灸杂志,2018,37(10):1132-1135.
[21]姚金,唐雨兰.针刺治疗糖尿病胃轻瘫的临床随机对照研究[J].成都中医药大学学报,2018,41(1):75-78.
[22]冯庆春.中西医结合治疗糖尿病性胃轻瘫的诊治进展[J].实用糖尿病杂志,2018,14(2):70-71.
[23]陈永,乐毅敏,杨宗保,等.梁门穴的基础研究及临床运用[J].江西中医学院学报,2012,24(4):17-21.
[24]陈建华,孙祎.关门穴与治疗部位神经相关性解剖学研究[J].中国中医药现代远程教育,2015,13(5):67-68.
[25]赵志恒,付田昊,焦召华,等.“门”穴与脏腑经络的规律探析[J].四川中医,2015,33(7):15-17.